Abstract:
We assessed the impact of the pandemic on TB diagnostics at primary healthcare clinics (PHCs) during
the different stages of COVID-19 in eThekwini district, South Africa. Data from the District Health
Information System (DHIS) were used to conduct an interrupted time series analysis that assessed
the changes in TB investigations and confirmed TB cases during four pandemic periods: lockdown
and the subsequent three peaks of infection compared to the two years prior (2018–2022). The initial
lockdown resulted in − 45% (95% CI − 55 to − 31) and − 40% (95% CI − 59 to − 28) immediate declines
in TB investigations and confirmed cases, respectively. Both indicators showed substantial recovery
in the months after the first wave (p < 0.05). However, while TB investigations sustained smaller
declines throughout the pandemic, they rebounded and surpassed pre-COVID-19 levels by the end of
the investigation period. On the other hand, confirmed cases experienced reductions that persisted
until the end of the investigation period. TB diagnostic services at PHCs were considerably disrupted
by COVID-19, with the confirmation of cases being the most adversely affected throughout the
pandemic. The reasons for these persistent declines in TB detection must be determined to inform the
development of sustainable diagnostic systems that are capable of withstanding future pandemics.
